Bilateral optic neuritis as a first presentation of lymph node tuberculosis.

Area of Science:

• Neurology
• Infectious Diseases
• Ophthalmology

Background:

• Tuberculosis (TB) can manifest with diverse neurological complications.
• Optic neuritis is typically associated with immune-mediated conditions.
• Diagnosing extrapulmonary TB can be challenging, especially in immunocompetent individuals.

Purpose of the Study:

• To report a rare presentation of lymph node tuberculosis (TB) in an immunocompetent adolescent.
• To highlight the diagnostic challenges of TB presenting as optic neuritis.
• To emphasize the importance of considering TB in atypical neurological presentations.

Main Methods:

• Case report of an immunocompetent teenage girl with bilateral optic neuritis.
• Clinical evaluation including detailed history and neurological examination.
• Advanced imaging with whole-body PET/MR.
• Targeted lymph node biopsy for histopathological confirmation.

Main Results:

• The patient presented with bilateral optic neuritis, initially suspected to be immune-mediated.
• Unusual features included transient visual obscurations, prominent disc swelling, and lack of supportive laboratory findings for immune causes.
• Whole-body PET/MR revealed extensive mediastinal and supraclavicular lymphadenopathy.
• Despite negative interferon gamma release assay and normal chest X-ray, lymph node biopsy confirmed TB.

Conclusions:

• Lymph node tuberculosis can present atypically with neurological symptoms like optic neuritis.
• A high index of suspicion and comprehensive diagnostic workup are crucial for TB diagnosis in unusual presentations.
• Integrated imaging modalities and targeted biopsies are vital for confirming TB in challenging cases.